FOCUS ON HEALTH: Too Poor to Be Healthy; in One Way or Another Each of the Main Political Parties Have Pledged to Address Poverty and Deprivation in Wales. in the Fourth Part of Our Pre-Election Health in Focus Week, Health Editor Madeleine Brindley Explains Why They Must Not Be Allowed to Renege on These Commitments, Regardless of Whether They Win Power or Not

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Byline: Madeleine Brindley

AN apple a day may keep the doctor away, as the saying goes, but what if you can't afford apples because the weekly income goes further on processed food or you can't easily reach the shops that offer ample fresh produce?

And even though you know smoking will be the death of you, could you give up what has become the one luxury in your day spent struggling to make ends meet and juggling budgets to make the few pounds left in your pocket go that little bit further?

Your health may be written in your genes but your susceptibility to disease has as much to do with where and how you live your life as it does your genetic heritage.

Imagine a map of Wales that is coloured in different shades to indicate where the pockets of deprivation and ill health lie. It will come as little shock that the two correlate almost exactly with the darkest areas concentrated in the former South Wales coalfields.

The links between deprivation and ill health are widely known but it is only now that we are tentatively starting to address them.

The Black Committee said, in 1980, ``While the health service can play a significant part in reducing inequalities in health, measures to reduce differences in material standards of living at work, in the home and in everyday social and community life are of even greater importance.''

The former chief medical officer, Sir Donald Acheson, said in his On the State of Public Health report 10 years later that, ``the issue is quite clear in health terms: that there is a link, has been a link and, I suspect, will continue to be a link between deprivation and ill health.

``Analysis has shown that the clearest links with the excess burden of ill health are low income, unhealthy behaviour, poor housing and environmental amenities.''

And Richard Wilkinson, a senior research fellow at the University of Sussex, added, ``Among the developed countries it is not the richest societies that have the best health but those that have the smallest income differences between rich and poor. Inequality and relative poverty have absolute effects: they increase death rates.''

Children born to poorer families are at the greatest health disadvantage - they are at much greater risk of prematurity, low birth rate and infant mortality; illness and disability; injury and accidents.

``The links between poverty and child health are extensive, strong and pervasive,'' said the Poverty and Social Exclusion Survey of Britain. ``Virtually all aspects of health are worst among children living in poverty than among children from affluent families.''

Wales is the sick man of Europe - the results of ``a noxious cocktail'' of poverty, lifestyle and diet, according to Professor Kevin Morgan, of Cardiff University - with some of the worst life expectancy rates throughout the continent.

The death toll from heart disease is significantly higher here than elsewhere in Europe, incidences of cancer are higher and a much larger percentage of people living in Wales have a long-term limiting illness, particularly in the South Wales valleys where there are fewer GPs employed, than elsewhere in Britain.

But even within the country there are large variances in health between the affluent and the deprived. …