This briefing from the British Lung Foundation explains the strong links between lung disease, deprivation and health inequalities. It outlines the main environmental drivers of lung disease – smoking, outdoor and indoor air pollution, and occupational hazards \u2013 and explains how socio-economic status affects exposure and outcomes.<\/p>\n
It makes the case that, given tackling health inequalities is a UK government and NHS England priority, the need for a respiratory taskforce to drive improvements is overwhelming.<\/p>\n<\/div><\/div><\/div><\/div><\/div>
Health inequalities refer to preventable differences in health outcomes across different population groups such as geographical, race ethnicity, sexual orientation or socioeconomic status\u00a0(1)<\/em>.<\/p>\n In England, people living in the poorest areas will die, on average, seven years earlier than those in the richest areas. The gap in disability-free life expectancy is even greater at 13 years. The landmark report Fair Society, Healthy Lives by Sir Michael Marmot makes the case that reducing health inequalities is an urgent matter of social justice\u00a0(2)<\/em>.<\/p>\n The BLF\u2019s\u00a0Battle for Breath<\/em>\u00a0\u2013 the report of a three year epidemiological study into lung disease \u2013 is one of various publications that have explored the link between lung disease and levels of social deprivation, identifying inequalities in a range of lung conditions\u00a0(3)<\/em>. Overarching observations show:<\/p>\n Smoking<\/strong> Smoking is generally more common amongst the most deprived communities:<\/p>\n Smoking is more common amongst people with mental health problem:<\/p>\n Certain ethnic groups are more likely to smoke than others. Smoking is comparatively prevalent amongst Black Caribbean (37%) and Bangladeshi (36%) men and White English women (26%)\u00a0(15)<\/em>. Similarly, smoking rates amongst gay and lesbian people are higher than the general population at 24.2% (2014)\u00a0(16)<\/em>.<\/p>\n People who are homeless are more likely to smoke. Groundswell\u2019s audit of the respiratory health of homeless people \u2013 Room to Breathe \u2013 found that 85% of homeless people smoke\u00a0(17)<\/em>. Smoking rates in prisons \u2013 with prisoners highly likely to have experienced poverty and mental health problems \u2013 are extremely high, at around 80%\u00a0(18)<\/em>.<\/p>\n Outdoor pollution<\/strong><\/p>\n Outdoor air pollution from vehicle emissions is linked with various lung conditions in adults and children\u00a0(19)<\/em>. Both nitrogen dioxide (NO2) and particulate matter (PM) can cause or worsen lung disease.<\/p>\n There is an established link between the prevalence and impact of outdoor air pollution and socio economic deprivation:<\/p>\n Other population groups are disproportionately affected by air pollution \u2013 older people are more vulnerable to air pollution, particularly older women due physiological differences\u00a0(23)<\/em>. Evidence also shows that black people are disproportionately likely to breathe illegal levels of air pollution in London, almost certainly linked to living in the more deprived areas\u00a0(24)<\/em>.<\/p>\n Housing<\/strong><\/p>\n Poor housing is linked to respiratory disease. Mould spores and dust mites, which can lead to asthma and general respiratory irritation\u00a0(25)<\/em>, are most common in damper, less well constructed houses\u00a0(26)<\/em>. This impacts on people who are on the lowest incomes and have the least ability to afford a better home.<\/p>\n People in the most acute housing need are particularly at risk. Homeless people are likely to have very poor respiratory health: 64% reported having had chest infections, 20% reported having asthma and 4.9% had diagnosed COPD \u2013 the latter two are double the national average\u00a0(31)<\/em>.<\/p>\n Occupational hazards<\/strong><\/p>\n Occupational hazards contribute to respiratory problems, notably COPD, mesothelioma and lung cancer\u00a0(32)<\/em>. Workers with fewer skills and qualifications are more likely to be exposed to these hazards:<\/p>\n Tackling health inequalities has been identified as a priority by both the UK government and by NHS England. Fighting against the \u201cburning injustice\u201d that those born poor will die earlier than others was outlined by Prime Minister Theresa May as one of her very first policy priorities\u00a0(37)<\/em>.<\/p>\n Tackling health inequalities is an important part of NHS England\u2019s current policy objectives:<\/p>\n It is also an important part of the NHS Outcomes Framework, used to hold NHS England to account:<\/p>\n We are calling for the establishment of an\u00a0independent respiratory health taskforce for England<\/strong>. This taskforce should develop a strategy for a national, joined up approach for improving respiratory health and reducing the inequalities in respiratory outcomes.<\/p>\n We have already seen the establishment of taskforces for cancer and mental health, which have led to positive outcomes. For cancer, this has included setting up \u2018Cancer Alliance\u2019s across England to plan local cancer services and design care pathways. For mental health, it has led to \u00a31 billion extra funding.<\/p>\n Given that lung disease is one of the top three killer diseases in the UK and mortality rates have not moved in 15 years, we believe it is time to take a similar approach to respiratory health.<\/p>\n This taskforce, made up of representatives from the NHS, respiratory health charities and others, would succeed in driving improvements. It would:<\/p>\n We would greatly appreciate it if you could take forward the following activity on our behalf. We are happy to provide you with any materials or further information.<\/p>\n For further information, please contact:\n
Factors<\/h3><\/a><\/li><\/ul><\/div>
What factors drive inequalities in lung health?<\/h3>\n
\nSmoking is a considerable causal factor of lung disease and premature mortality. Of all the hospital admissions for respiratory problems in 2014\/15, 23% were directly attributable to smoking\u00a0(4)<\/em>. Of the 115,000 lung disease deaths each year\u00a0(5)<\/em>, up to 58,500 are attributable to smoking. This includes 86% of all lung cancer deaths\u00a0(6)<\/em>, and 77% of all COPD deaths\u00a0(7)<\/em>. Around 16.9% of adults in England smoke\u00a0(8)<\/em>.<\/p>\n\n
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Tackling health inequalities<\/h3><\/a><\/li><\/ul><\/div>
Why is tackling health inequalities important?<\/h3>\n
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Taskforce<\/h3><\/a><\/li><\/ul><\/div>
How a taskforce would reduce health inequalities<\/h3>\n
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Support and references<\/h3><\/a><\/li><\/ul><\/div>
Support our campaign<\/h3>\n
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\nBen Chiu, Policy Officer \u2013\u00a0ben.chiu@blf.org.uk<\/a>\u00a0\/ 020 7688 5612<\/p>\n