DoH’s Health Inequalities; Regional Report, 2016, just published, tells us positively that in general as a population we are in great shape. In spite of our national moaning about our poor health – and interminable complaining about the inadequacies of our health service – we are as a fact, on average, healthier than we ever have been with access to the most amazing services and procedures. We now live to 80; 100 year ago the average age of death in Belfast was a miserly 45 years.
For our improved health our Health Service sadly cannot claim full credit. Rather a combination of public health initiatives has created a situation where perhaps 10% of those born in 2000 will live to see the 22nd Century.
Off course the rich have always lived longer and healthier lives than the poor so we became obsession in the 1980s about social inequalities in health and have tried to reduce these through government policy. Inequalities – or health gaps – exist as a marker of social unfairness and it persists, proving difficult to doing much about. DoH is keen to show that gaps are reducing and to be fair that is happening to some degree and that’s why it’s important that we get this publication every two years.
For me the standout figure in the 2016 report is on respiratory disease. Rather than reducing, respiratory disease, in both rich and poor, is increasing and the gap remains the same. This makes little sense as we are smoking less – now 22% of the population down from 24% – and smoking is the main driver for chronic obstructive pulmonary disease (COPD). To make sense of this disappointing figure we might need to go back in time and further afield.
Sixty-five years ago this month London experienced four days of deadly, eye-gouging, throat-ripping smog that sent 100,000 in their beds if not to their local hospital whose medical and nursing staff struggled to cope. Within months, and as a result, 4,000 additional deaths were recorded and government, in what was a timely wake-up, enacted a Clean Air Bill which cleaned up the air of our major cities, including Belfast, and it is this Act that, to this day, stops us burning coal in the grates of homes which still have grates. The Clean Air Act mostly ignored pollution from the increasing traffic congestion in the city. Cigarette smoking, a habit that more than 60% of the UK male population participated in back then, was not controlled at all since the link between smoking and disease, particularly respiratory disease, was then unknown.
New Delhi suffered a similar problem this December and last. The problem, like London in ‘52, was a combination of excessive burning. Farmers to the north of the Indian capital traditionally burn crop stubble in late November when the harvest is complete. Weather in the region at this time of year is controlled by a high pressure system that slowly moves south where it envelops the teaming city already much polluted by the millions of internal combustion engines that runs the city and off course smoking prevalence in the Indian population is much higher than here.
Off course cigarette smoke is a much more serious respiratory toxin than environmental smoke and emissions but the public health impact of environmental pollution is always exacerbated many fold in smokers. If you were a smoker in London back in 1952 or a smoker in New Delhi in December 2016 or 2017, then you were much more likely to end up in the morgue or on a funeral pyre. Smokers are more sensitive to air pollution whether it be from fires or engines.
And here’s my concern; our DoH statistics might be giving us a very clear signal that smokers in Belfast, one of the most traffic congested UK cities and one that enjoys considerable seasonal bonfires, are showing up as a real health impact. We clearly need to get people to stop smoking but we also need to reduce traffic pollution and pollution from bonfires.