Health and income inequalities over generations – what can be done?

Dr Heather Brown

How have inequalities changed over 25 years, and how can we target policy to make sure it reduces inequality?

We know there is long term inequality in the UK. People who are born poor largely stay poor. However, we don’t have enough evidence on the persistence, over generations, of worse physical and mental health for people from poor backgrounds, and whether – or how – it’s related to income.

Since September 2018, I’ve been using Understanding Society data – on a year-long Understanding Society Policy Fellowship – to examine the relationship between income and health.

What is ‘intergenerational persistence’?

If we take out any genetic component in someone’s health, we still see poor health and low wages continuing across generations. Much of that is down to structural factors: how the economy works, how we provide social security, the design of the health care system, and differences in people’s access to work and educational opportunities.

In childhood, for example, poor health can affect how well we do at school, which affects what you can earn as an adult. Then, in adulthood, poor health reduces the hours we’re available to work, and it can increase the likelihood of developing a chronic condition, which could reduce those hours further – or even our ability to work at all.

Why does it matter?

It’s easy to see such problems as entrenched, and think that nothing can ultimately be done, but there are two reasons why we should try. The obvious argument is the social one: doing something about this is in the interests of justice, fairness, and equality of opportunity. But there is also the economic argument: families with persistently poor health and lower wages will have higher health care and social security costs. That cost to the state can be mitigated by intervening intelligently – and sooner – to break the cycle.

What works?

I want to look at specific policies, to see which ones work, and to identify where to focus government policies in ways which have the greatest impact. Between 1997 and 2010, there was a targeted government strategy to reduce poverty – especially poverty which affected children and the elderly. Since 2010, there has been a clawing back of the welfare state, so I’m looking at data from the beginning of the British Household Panel Survey in 1991 through to Understanding Society data in 2016. I want to see if the correlation between low income and poor health changed over that time.


I’ve found that the correlation across mental health, physical health, and wages over generations is stronger in the North than in the rest of England – and it’s increasing over time. (I’ve defined ‘the North’ by a line drawn roughly from the Severn estuary to the Humber.) For the rest of England, the correlation between wages and physical health is decreasing.

What this means is that mobility is declining faster in the North of England than in the rest of England. More young people are following their parents into an adult life of low wages and poor health. This has consequences, not just for their future prospects, and for future generations, but for economic growth and health care spending, which affect us all.

Real impact – informing policy

We know that:

  • there’s a substantial health gap between the north and south of the UK
  • average life expectancy is two years lower in the north
  • being born in a poor family sets people on a likely lifetime trajectory of poor health and poor economic outcomes

We need to know what the best policy or combination of policies is to level the playing field for young people and families – to improve social mobility and reduce health and income inequalities. Is there, perhaps, a role for policy aimed at reducing costs and improving care for older people – thus freeing up family resources, and facilitating mobility?

Part of my remit as a Policy Fellow is to engage with policy makers, including government departments, so I’ve been holding a series of workshops to discuss my findings, and to look at measures which can work.

Taking part in those sessions with me have been people like Professor Jim McManus, Vice President of the Association for Directors of Public Health, Baroness Sally Greengross a member of the Intergenerational Fairness and Provision Committee, and Sharon Hodgson, the Shadow Secretary for Public Health.

Even with limited resources, we’ve found, local authorities can take action to promote good health in families in disadvantaged communities. For example, it’s possible to use local planning laws to reduce the number of fast food outlets in particular neighbourhoods – and councils can require developers to think about green space when building new homes.

One way to create a virtuous circle – and for policies backed by limited resources to generate more ‘bang for their buck’ – is what used to be called ‘joined-up government’. If researchers provide evidence which is relevant to policy, but it only reaches one government department, our impact is limited. There is still too much compartmentalisation of government, and what’s vital in the future – especially if budgets continue to be limited – is that any new policy, on any subject, should take into account the implications for people’s health.

I’ll be publishing two papers as a result of this fellowship, and I hope the impact of my work will be felt widely, by the people who need our help the most.


Dr Heather Brown

Heather Brown is a senior lecturer in the Institute of Health & Society at Newcastle University, and an Understanding Society Policy Fellow