My message to the NHS about tackling the health effects of poverty

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Ladies, gentlemen,

This urgent message comes to you from a Dutch earth & life scientist who’s previously lived in the US and has been in the UK since the end of 2004.

Please get a working group together and start addressing the health effects of poverty. Because not doing so would constitute a healthcare failure and risks amplifying the health disparities that Covid has so sharply highlighted. It also risks exposing the NHS to high but largely preventable expenses further down the line.

Poverty in general

For historical reasons (the result of decisions made by a long sequence of UK governments), approximately one third of people are living in poverty in the UK. Many of those millions of people are stuck in deep poverty, which means that they have trouble paying for basics such as food and energy. This is simply because their income is too low to cover those basics. You can’t eat your IQ or your street smarts and you can’t use them to fuel your boiler and heat your home either.

With energy prices skyrocketing and food prices rising, none of this being compensated for by wage rises or benefits increases, the number of people in deep poverty in the UK is bound to go up. It is my experience that NHS trusts and GPs pay little attention to the health effects of prolonged deprivation and in my view, you need to start educating your people and create new policies.

GPs seem completely unaware of the health effects of poverty and I think that that’s because they have no idea what poverty means in real life. Poverty is just a word to them, but it is also often a word that permits many medical professionals to dismiss people’s health complaints (because the class system is still so firmly ensconced in England).

Vitamins and minerals

GPs and other medical professionals have to be able to prescribe mineral and vitamin supplements. Good supplements are available from notably Wilko at a very reasonable price. GPs could start stocking up on them and handing them out to people who strike them as not being in their own income bracket. For example, people’s calcium, vitamin D and Vitamin A and C requirements and/or iron requirements will increasingly often not be met in view of their deteriorating economic circumstances and general vitamin and mineral intake is bound to start dropping too. It is important to not just prescribe a multivitamin, but multivitamins that include minerals.

In some cases, a multivitamin with iron or merely vitamin D with calcium may be needed. In older adults, nutritional deficiencies can cause their bones to become brittle and it can also make them more vulnerable to infections. For menstruating women, particular iron deficiencies can have serious health effects. Nutritional deficiencies can also cause tendons to become much more prone to injury and slow to heal.

Remedying the cumulative effects of such deficiencies at a later stage can become a very costly affair whereas handing out vitamin and mineral supplements early may be able to prevent this.

The food handouts that are taking place all over the country do not prevent the development of deficiencies, for starters because their accessibility is limited (limited hours and locations that can be at some distance).

In addition, handed out packets of crisps and unsold Easter chocolate eggs are a nice treat and help people going but are usually nutritionally worthless. Don’t expect a great deal of knowledge from volunteers at official food banks either. Rehydration, for example, is more than a matter of giving people a bottle of water. Hot weather as well as starvation can affect the electrolyte balance in the human body. A good rehydration drink can work wonders in such situations, whereas mere water often won’t have much of an effect.

Medical professionals should start asking patients questions such as the following:

  • “have you eaten today?”
  • “when was the last time you had a proper meal?”
  • “are you getting at least three decent meals per day?”

    and should then ask them what they actually ate and not be satisfied with a yes or a no as well as enquire

  • “what is your home situation like? are you able to heat your home, for example?”

Not doing so constitutes a healthcare failure.

Poverty effects on children

I would like you to pay special attention to youngsters. As you probably know, there is a belief in the western world that the taller a person is, the bigger his or her pay check is likely to be because many studies have shown this correlation. There have also been studies, however, that suggest that this is about childhood nutrition and childhood development and that it is in fact childhood nutrition that is the predictor of one’s later attained level of education and the size of one’s pay check in adulthood.

Effects of choosing food over electricity and/or gas

I also want you to start educating medical professionals on the effects of people’s prolonged inability to heat and power their homes.

  1. When people choose to pay for food rather than for their (prepaid) electricity and gas, first of all, this means that the wall and window surfaces in their homes can become too cold. As you know, the amount of moisture that can be contained in air is related to the air’s temperature. When warmer air meets cold surfaces, this causes condensation, sometimes to the extent that water is literally dripping down the walls, making some people mistakenly believe that there is a roof leak or that rainwater is seeping through. High levels of condensation promote mould growth. Cheap homes are often created with the cheapest materials possible; this often includes the use of inappropriate paints in bathrooms and kitchens, which can not only encourage encourage mould growth on wall surfaces but even inside the building materials themselves.

  2. Cheap homes can be very dark. For some people, who are out of work or who are pensioners, going without electricity (lighting) can cause their adrenaline – serotonin cycle to go off-kilter. This can make people drowsy during the day and it can also impact their mood. This danger is greater when it is combined with nutritional deficiencies (think for example taurine intake). I therefore believe that in some cases it may also be appropriate to prescribe 5-HTP, a food supplement that for example is available from Holland & Barrett, to be taken in the evening. In addition to mood and level of alertness, it can improve sleep quality as well.

  3. Going through cycles of food deprivation and food supply may affect sugar metabolism.

  4. I volunteered during the Covid vaccination effort and in the medical practice where I was a steward, I noticed an NHS poster that advised people that the temperature in their home should be 18 degrees C or higher. That poster completely ignores the reality of life for so many millions of people in the UK. It almost admonishes people for failing to be able to heat their homes. It feels like a slap in the face. It made me wonder how informed and “with it” the NHS is.

    (It’s confusingly in contrast with other national campaigns that tell people to lower their thermostats by a few degrees. Can’t you consult with other organisations and coordinate your campaigns, please?)
  • Remember, also, that there was a recent uproar about “advice” from an energy company? I suspect that the uproar came mostly from people who have no idea what it is like to be living in a cold home and I also wonder if this advice came at least partly from people who do know what cold homes are like. When you are cold, for example, and this particularly applies for women as the blood flow in their extremities can become limited, exercising such as jumping up and down can help because it opens up the veins and arteries.

Where this letter comes from

I have learned these lessons because I have not only seen but also experienced prolonged deep poverty in the UK. I ended up destitute, isolated, baffled and taken aback first and angry and fuelled next. I can’t believe what’s happening here in the UK. I can’t believe how inequality is often promoted and justified at all levels of society and how much otherisation there is here. I can’t explain or even describe any of this to people in my home country because it’s all so utterly outside their realm of experience.

Prolonged poverty does not only disadvantage people because their nutrition suffers and the money worries may cause their IQ values to drop a few points, but it also gets them ejected from society, referred to the back door. Otherisation is so rampant in England that I too regularly have gotten and still get dismissed as a silly time-wasting nincompoop because I can’t walk into a store to talk to the manager or city council office that Boris de Pfeffel Johnson is my cousin and I don’t have the accoutrements that signal “status” and “wealth” and haven’t been introduced by my cousin. Prolonged poverty closes doors and shrinks your world. It gets you referred to the back door. The effort to change this might as well be spearheaded by the NHS as it fits perfectly with the reason why the NHS was established.

Age

Something similar as for poverty goes for age; older adults are “demonised” in the UK, as several studies have shown. I once encountered a local woman, a stranger, who asked me to help her with something as she had fallen and damaged her shoulder and as a result had a limited range of motion in that arm. She was told it was merely old age that she was suffering from when she sought medical assistance. She was told to learn to live with it. If only this were the main way in which older adults are constantly dissed in the UK, but it’s much worse than that. It is sad that health professionals are part of it too. Health professionals and police officers play a major role in perpetuating various forms of otherisation and stigmas.

When I mentioned muscle weakness to my GP, years ago, he too said that this was an effect of ageing and told me to join a health club. He knew – or should have known as he had access to the information – about my prolonged deprivation. (I’d even collected and processed acorns to survive for a while.) I was in my early 50s at the time. Back then, I was also suffering from tendon problems, which I too had ascribed to the ageing process, to be fair. However, my tendons improved markedly after I received a small inheritance from an aunt in 2013 and then had access to ample nutrition for a while. I learned the hard way that it can take tendons a while to recover. As you know, tendons are particularly vulnerable because their blood supply is limited. Therefore, nutritional deficiencies are likely to affect them first along with other tissues that are not well supplied with blood vessels. The resulting neuromusculoskeletal issues are likely preventable in most cases; they often hamper people greatly.

Skin tone

I haven’t even mentioned that US studies have shown that persons with a darker skin tone are much less likely to be referred for specialist care. This is part of the reason why Covid has affected them more than whites. Their healthcare complaints too are too often too easily dismissed and this is unlikely to be very different in the UK.

(For me, the pandemic restored my access to experts from academia and other organisations as so many meetings began taking place online. In the US, there is often much less separation between the general public and academics than in Europe, generally speaking, so I too was able to attend many meetings, such as from APHA/NAM and the Petrie Flom Center.)

Disabilities

I also haven’t mentioned that severely limited physically disabled people in the UK became emphatically more likely to go without food since the start of the pandemic. The curve went up sharply and by roughly mid 2020 the start of 2021, they were 4 to 5 times more likely to be food-deprived than regular folks. (Source: Food Foundation) 

I repeat:

Please get a working group together and start addressing the health effects of poverty. Because not doing so would constitute a healthcare failure and risks amplifying the health disparities that Covid has so cruelly exposed and sharply highlighted. It also risks exposing the NHS to amplified expenses further down the line.

If you address the health effects of poverty well and vigorously, you will be addressing health disparities for part of the BAME population and part of the groups of people with disabilities and neurodiversity challenges at the same time.

Thank you for your time and efforts.

Best regards,

Angelina Souren

PS
Among other things, I’m a graduate of an NCFE-accredited course in community leadership, a former associate editor of the newsletter of the Geochemical Society, a former member of the board and of several commissions of a Dutch foundation for women in science and technology and a former board member of the Environmental Chemistry (and Toxicology) Section of the Royal Netherlands Chemical Society. I’ve been self-employed since 1997.

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