The health of the people in economically disadvantaged (poor) communities in south Wales as elsewhere is relatively poor, and inequalities in health between the most and least disadvantaged are wide and getting wider. This issue has been the focus of considerable academic debate since the 1980s and inequality, including health inequality, is now regarded more widely as the issue that the UK is facing. Health inequalities are some of the most basic inequalities, there is probably no starker inequality than being alive or dead. The consequences of this poor health are, as I have said, premature death but also long-term disability, and exclusion from economy and society. An example of these health inequalities in South Wales can be seen in the example of the Cwm Taf health board area, which includes the former iron town of Merthyr Tydfil and the former coal producing area of Rhondda Cynon Taf (RCT). These two areas rank as worst overall in Wales for poor health, as measured by life expectancy, healthy life-expectancy and disability-free life expectancy.
The term ‘deprivation’ disguises many different realities and conceals the strengths and assets which many of these communities contain. Such communities therefore represent considerable and different challenges for social and economic development and health and welfare policy. The greatest determinant of health is socio-economic inequalities which further contributes to the further widening of those inequalities. People find themselves unable to work, or able to work only at considerably reduced levels because of long-term ill-health and disability; and their wider participation in society is restricted. In parts of the Cwm Taf area, situated within a classic well over 30 per cent of the population are living in poverty, on official definitions, and, as of 2009-10, 19 per cent of the population of RCT and almost 23 percent of the population of Merthyr Tydfil were claiming employment-related benefits.
A Message From Merthyr
A Message From Merthyr
As a case study of some of the issues faced by these communities on the northern outskirts of Merthyr Tydfil there is an area of known as the ‘Gurnos’. The Gurnos was initially constructed during the late 1950s and early 1960s to re-house those displaced by ‘slum clearance’ of dwellings around the former iron works and was seen as a symbol of renewal and regeneration. The estate continued to expand until the late 1970s but the loss of industrial production and rising levels of unemployment were followed by corresponding increases in social problems, such as crime, educational underachievement and substance misuse. Currently the estate comprises more than 2,500 council built properties. Owner occupation is relatively low at 27.5 per cent and Gurnos is one of the most deprived electoral wards within an already deprived area of Wales.
Gurnos symbolises many of the issues facing communities where the traditional heavy industries that gave a sense of identity and pride have been replaced by low skilled, low wage often transient factory work. This has created a sense of inequality and injustice, exacerbated by the proximity of economically buoyant Cardiff, and other affluent areas along the M4 corridor. The social reality of the area is informed by a certain notoriety well beyond the immediate locality and residents are only too conscious of this as it can compound the difficulties many of them face. This has engendered suspicion and cynicism, presenting difficulties for the development of research or health improvement projects led by people from outside the area.
While many of the big levers for health improvement lie outside Wales, in policies for the UK or Europe, at the level of locality, community cohesion can off-set some of the disadvantages created by inequalities in the wider economy and society . The complexity of problems in some of these communities is not easily understood and the problem with much community-targeted health initiatives is not that the communities are apathetic or worse seen as feckless but often community members are treated as if they are laboratory samples that need to have interventions done to them rather than conscious interpreters of their own situations who are rationally responding to the situations that they find themselves in.
It is important that any initiative which seeks to successfully address health inequalities in any poor areas understands and engages with the issues and barriers that people who belong to that community actually face. As an example, a healthy eating initiative that simply tells community members that the need to eat five portions of fruit and vegetables a day has little chance of success unless it engages with an understanding of the barriers that may prevent community members achieving this, be they psychological, cultural or logistic.