From Alan Taman, Birmingham, UK
Clare Wilson and Andy Coghlan cover many of the possible explanations for the decrease in the improvement of life expectancy in the UK (25 August, p 20). But they miss one out.
The effect is historically far more noticeable in the poor than the wealthy. There is a measurable gradient of difference across all social classes. This has been known since the time of the Whitehall studies into the health of UK civil servants, led by Michael Marmot (28 July 2012, p 42). The first of these, published in 1984, showed that civil servants in lower grades died on average sooner than those in more senior positions, though the latter had far more responsibility in their roles (and also tended to come from higher socioeconomic groups).
One crucial question is: why are poorer people affected more than those who are better off, across all societies? This is key to admitting to the presence of health inequality, and the injustice it entails. In turn, I would argue, it raises a key ethical question that anyone looking at changes in health outcomes needs to consider.
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