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Women Will Eliminate Poverty in the UK

Memo to Gordon Brown in April 2005 which was followed by a meeting at the Treasury.

Introduction

The purpose of this memo is to alert the Treasury to the high cost of inaction on the inequality of health with its origins in low birthweights. The Times 16th January publicises Gordon Brown on his visit to Africa recognizing women as the means to “deliver Africa out of poverty”. Brown articulates what the Mother and Child Foundation and Dr. Gro Brundtland, in one of her last speeches as Director General of the World Health Organisation, have identified as the most serious gap in efforts to eliminate poverty and the inequalities of health and prosperity.

Gordon Brown’s message needs to be applied to poverty in the UK. The core signal of poverty is low birthweights, which result in associated physical and mental ill-health. Dr. Joseph Hibbeln at the National Institutes of Health in the USA now considers that improper maternal nutrition is a key factor in the sharp rise in mental ill health amongst young people.

The incidence of low birthweight in the UK has risen from 6.6% 1953 and 1973 to 7.6% in 2003. The UK has the highest incidence of low birthweight in Western Europe. The UNICEF-WHO 2004 analysis just published has the UK at 8% on a par with Romania, Mongolia and Kazakhstan! In some inner city regions in the UK the incidence reaches developing nations’ rates of 11 to 14%. Low birthweight (<2.5 Kg) is probably the strongest predictor of morbidity, chronic ill health, cognitive disadvantage and behavioural pathology.

Incidence of Low Birthweight in the UK - The Cost to the Taxpayer

In view of the high cost to the nation, some consider there to be a serious misallocation of resources, one that is costing the Treasury and Tax Payer dearly. Money is consistently ploughed into the end-product of disease processes in hospitals, treatments and drugs with little done on prevention, as proven by the worsening birthweight statistics. The cost of the low birthweight, very preterm infants is running at £140 M per annum for their special care in hospital alone. In the normal population 1 or 2 per thousand live births will result in severe, neuro-developmental disorder such as cerebral palsy. At very preterm deliveries with birth weights below 1.5 kg, the incidence rises above 200/1000 with an estimated cost of £2 to £4 billion a year. The social costs to the parents and carers of the most severe cases of a child requiring 24 hour nursing care is incalculable.

At a conference on the brain that we organised 14th May, last year at the Royal Society, Mike Raynor from the British Heart Foundation audited the cost burden of ill health in the UK. Whilst heart disease was no surprise at no. 1 cost, psychiatric disorders or mental ill-health followed a close second accounting for over 40% of the “Years of Life Lost in Disability” and a direct cost alone of £12.5 billion a year (data from Wanless). The cost of vascular disease, which the MRC claims to have a foetal origin, adds another £13.5 billion. Bearing in mind the ONS data on the socio-economic disparity (above), the proportion of what might be saved is a large amount. The costs in this paragraph amount to about £30 billion.

However, this is the tip of an iceberg. The long-term effects on mental ill health and cognitive disadvantage results in poor school achievement, behavioural pathology, reduced job opportunities and ultimately a shortfall of skilled workers. Whilst there are many factors associated with low birthweight and preterm delivery, our studies in the East-end of London describe poor maternal nutrition as a major risk factor independent of social class, ethnicity and smoking. The cost of resultant chronic ill health such as diabetes, heart disease, stroke, immune disorders and the mental-ill health must account for a very substantial part of the NHS budget.

Bad Maternal Nutrition and Mental Ill Health

In 1972, we wrote a book. It was based on the results of my research, sponsored by the Medical Research Council, which had identified the special requirement of long chain, super-unsaturated fatty acids for the growth and function of the brain. It was well known at the time that bad fat nutrition was a causative factor in atherosclerosis, the basic problem of cardio-vascular disease. Prenatally the foetal brain consumes for its growth 70% of the dietary energy coming from the mother. The delivery to meet this prodigious requirement requires healthy blood vessels. Based on the evidence at the time, and the knowledge that the brain is the best-protected system, we predicted in the book that the next system to be affected would be the brain.

This 1972 prediction has been fulfilled with the rapid rise in mental-ill health following from country to country the previous rise in death from heart disease in the last few decades. Moreover, it is escalating in young people, the more recently born being the more seriously affected. If this rise in mental ill health continues this century as heart disease did last, then we face some grave social and political consequences.

Good Maternal Nutrition Vital To Economic Success

On the economic front, Roderick Floud led the Cambridge Group of Economic Historians who wrote a book entitled “Health, Height and History”. Ten years in the synthesis of economic history from Roman times, the group concludes that economic fortunes of a population were inextricably linked to health. They state that the most important variable down the ages was the nutrition of the population and its work force. With the evidence on the effects of poor nutrition undermining pregnancy outcomes and the efficiency of the adult, it is not difficult to see how this link would operate. This force was well recognised during World War II as the politicians had learnt the impact of poor nutrition on the fighting force from World War I. In the postwar thrust for “growth”, this message was simply lost with the serious backlash on health that we have today.

By contrast economic, social, health and educational measures have bought down the incidence in our European competitors so that the rate of low birth weight in the UK is the highest in Europe and in some instances more than twice that of other EU countries. Many of the European nations research the minimum incomes needed for healthy living to inform the levels of welfare, which contributes to their lower incidence of low birthweight; a rational procedure not officially implemented by any UK government.

Previous Governments Apprised

The present situation is not because Government has not been apprised of the matter. The House of Commons Select Committee on Maternity Services (Nicholas Winterton) was fully informed and recommended action. There have been several meetings with various charities and the President of the Royal College of Obstetrics and Gynaecology making representations on the need and what to do, to the Health Department. None have been acted on. What little effort they are making now is inadequate.

Recommendations

The solution to poverty in the UK and the elimination of the inequalities of health is in getting it right at the start of life. It lies in breaking the cycle of deprivation by finding ways, financial and otherwise, to help the mothers and women lead Britain out of its inequalities. It requires a cross departmental effort. There will be opposition because of vested interests and entrenched attitudes. However, the Treasury is the department that will pick up the escalating bill of health and social care.

It is also clear that Gordon Brown recognises the significance of the women in the solution. Because of this, we see the Treasury as the department best suited to create the initiative. A working party could define a strategy, whilst individual departments could work out ways and means by which they would address the problem.

The first priority needs to be the reduction in low birthweight and for this we need a multi-disciplinary approach immediately applied to the health of the mother before conception, at the beginning of and through pregnancy, and followed up to embrace schools, teachers, parents with initiatives that range from education to food and agricultural policy and the Home Office, together with the DTI to take advantage of UK resources.

We are facing a multi-generational problem, which will not be solved over night. The consequences of inaction are unthinkable. The rewards of successful action would be a rise in health, economic and social standards and last for decades.

Dr. Michael A. Crawford PhD, CBiol, FIBiol, FRCPath.

Chairman of the McCarrison Society and a Director of the Mother and Child Foundation. {}

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