Inventing our future Collective action for a sustainable economy

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Access to health care and other services
4.35 A fourth key element of ‘living and working conditions’ that has a material bearing on people’s health
experiences and health outcomes – and inequalities in both – relates to access to services. Poor access
to services is a key cause of socio-economic exclusion. Nationally, it has been observed that ‘lack of
access to transport is experienced disproportionately by women, children, disabled people, people from
minority ethnic groups, older people and people with low socio-economic status, especially those living
in remote rural areas’. 72 Survey evidence suggests that 31% of people without a car have difficulties
travelling to their local hospital compared to 17% of people with a car. 73 Within the East of England,
the Regional Social Strategy identifies similar concerns. It reports that a third of the 50,000 lone parents
and 60% of pensioners in rural districts of the East of England do not own a car and are therefore
likely to be seriously disadvantaged in terms of access to services; older single women pensioners are
identified as the group of greatest concern.
III: Social and community networks
4.36 Evidence suggests that people’s experience of health and the actions they take to maintain good health
are strongly influenced by their upbringing and family culture, peer groups, the media and health
professionals. Typically, people with robust and diverse social networks have stronger immune systems,
suffer less from heart disease, recover more quickly from emotional traumas such as bereavement,
and seem to be more resistant to the debilitating effects of illness; this is explained in terms of social
networks providing support and affirmation, including practical advice around health matters. 74
4.37 Although there are exceptions, 75 high levels of social capital will generally contribute to enhancing
people’s health. ‘Social capital’ is defined as ‘the networks, norms, relationships, values and informal
sanctions that shape the quantity and co-operative quality of a society’s social interactions;’ 76 more
simply, it can be considered as the ties that exist across families and communities and that help
structure people’s everyday lives. Whilst causality is difficult to prove, evidence suggests that where
social capital is weak, support for families and investment in community development can contribute
in important ways to improving health outcomes. The implication – as one report has put it – is that
‘policies to reduce social inequalities and to promote social networks are part of a strategy to reduce
inequalities in health in just the same way as action on economic inequalities or improvements in the
material environment of disadvantaged communities.’ 77
4.38 In this context, the voluntary and community sector plays a key role. For an individual, the process
of engaging in activities linked to the voluntary and community sector is itself indicative of some kind
of network: people are largely recruited through word of mouth or knowing someone who is already
involved. But the value of the voluntary and community sector goes further; much voluntary and
community sector activity is linked – directly or indirectly – to the wider determinants of health
through, for example, neighbourhood, sports and cultural associations.
72 Independent inquiry into inequalities in health report, chaired by Sir Donald Acheson, published by the DH/The Stationery Office (Crown copyright),
1998 page 56.
73 Making the Connections: Final Report on Transport and Social Exclusion Report by the Social Exclusion Unit (Crown copyright), February 2003
74 ‘Community development and networking for health’ Chapter by Alison Gilchrist in Public Health for the 21st Century edited by Orme et al (2003),
Open University Press.
75 E.g. peer pressure and social activities are known to support unhealthy habits, particularly among young people, in relation to smoking, drug use,
alcohol consumption, etc.
76 See Aldridge, S and Halpern, D ‘Social Capital: A Discussion Paper’ (2002), Cabinet Office: PIU.
77 Independent inquiry into inequalities in health report, chaired by Sir Donald Acheson, published by the DH/The Stationery Office (Crown copyright),
1998, page 17.