Closing the Divide

Health is often sold as something expensive: superfoods, supplements, gym memberships, retreats and the latest gadget. It's easy to believe that good health is only for those who can afford it. But many of the most powerful things we can do for our health cost little or nothing at all. Fresh air, daylight, sleep, walking, friendship, simple home-cooked food, and herbs growing freely in hedgerows and gardens. Good health should be within everyone's reach.

A divided nation

In England, people living in the poorest areas can expect to live in good health for around 19 years fewer than those in the wealthiest areas: around 52 years of good health, compared with around 71. They also die sooner, by nearly ten years for men and eight for women.¹ In other words, many people in our poorest communities are living with long-term illness or disability by their early fifties. In 2010, Professor Sir Michael Marmot's landmark review, Fair Society, Healthy Lives, showed that health follows a "social gradient": at every step down the ladder of income, education and housing, health gets worse.² Ten years on, his team found that the gap had grown wider, and that improvements in life expectancy had stalled.³

Inequality isn't only about money. In the UK, Black women are around three times more likely to die in pregnancy or soon after than white women,⁴ and many women report that their symptoms have been dismissed or not taken seriously, leading the government to publish its first Women's Health Strategy for England in 2022.⁵ And, as we'll see, men face health gaps of their own.

What lies behind the gap

The gap isn't caused by rare diseases. More than half of the difference in life expectancy between the poorest and wealthiest areas comes from three everyday killers: heart disease and stroke, cancer, and lung disease, with heart disease, lung cancer and chronic lung conditions such as COPD contributing most.⁶ These are largely preventable conditions, which is exactly why the gap is so unjust.

Illness also arrives far earlier. A study of nearly two million people in Scotland found that those in the most deprived areas developed two or more long-term conditions 10 to 15 years earlier than those in the most affluent areas, and were much more likely to live with physical and mental health problems together.⁷ (See Where Body Care Meets Mind.)

Why? The causes are layered, and they reinforce each other:

• Smoking. In 2021, nearly a quarter of adults in England's most deprived neighbourhoods smoked, compared with around 1 in 15 in the least deprived.⁸ Smoking remains the single biggest driver of the gap in heart disease, lung cancer and COPD.
• Chronic stress. Money worries, insecure work, debt and overcrowding keep the body's stress system switched on. Over years, this "wear and tear" raises blood pressure, blood sugar, inflammation and belly fat, and disturbs sleep and mood.⁹ (See The Cortisol Clock.)
• The food on the doorstep. Poorer areas tend to have more fast-food outlets and fewer shops selling affordable fresh food,¹⁰ and when money and time are short, cheap, filling, ultra-processed food is often the easiest option. (See Real Food, Real Health.)
• Housing and air. Cold, damp and mouldy homes harm the lungs and heart, and busy roads bring more air pollution, while there's often less green space for walking, playing and calming down.
• Work and money. Insecure, low-paid or physically hard work, long or shift hours, and unemployment all take a toll, and leave less time and energy for looking after health.
• Getting care later. People in poorer areas are less likely to take up cancer screening and health checks, and often find it harder to get time off work or travel to appointments, so illnesses tend to be found later.

None of these are personal failings. They are the conditions people live in, and they shape health long before anyone sees a doctor. That's why real solutions work at two levels: practical support that makes healthy choices easier for each person, and a fairer society that removes the causes. Professor Marmot's reviews call for both, from a good start in childhood and fair, secure work, to a decent income for everyone and healthy, sustainable places to live.³

Help that's there to use

Some of the most effective support is free, yet often goes unclaimed:

• Stop smoking support. Free NHS Stop Smoking Services offer expert support and treatment, and people who use them are far more likely to quit for good than those who go it alone. Search "NHS stop smoking" or ask at a local pharmacy.
• Screening and health checks. NHS bowel, breast and cervical screening, and the free NHS Health Check for adults aged 40 to 74, find problems early, when they're most treatable. Taking up every invitation is one of the simplest ways to protect yourself.
• Healthy Start. If you're pregnant or have a child under four and receive certain benefits, you may be eligible for a free prepaid card to spend on fruit, vegetables, pulses and milk, plus free vitamins.
• Free school meals and holiday activity and food programmes for eligible children.
• A benefits check. Billions of pounds of support goes unclaimed every year. Free, confidential benefit calculators from charities such as Turn2us, or advice from Citizens Advice, can show what you're entitled to.
• Warmer homes. Help with energy bills, such as the Warm Home Discount, and local council schemes for insulation and heating can make homes warmer, drier and healthier. (See Lightening the Load on damp and mould.)
• Community food. Community pantries, fridges and food co-operatives offer good food at low cost, often with cooking clubs and friendship too.

The cost of eating well

It's true that, calorie for calorie, healthy food in the UK costs more than unhealthy food, and that the gap has widened over time.¹¹ The Food Foundation has calculated that the poorest fifth of households would need to spend around half of their disposable income to follow the government's healthy eating guidelines.¹² That's a real and serious barrier.

But some of the most nourishing foods of all are also among the cheapest:

• Beans, lentils and chickpeas, dried or tinned, are packed with protein, fibre and minerals for pennies a portion.
• Oats make a filling, blood-sugar-friendly breakfast for very little.
• Frozen vegetables and fruit are picked and frozen at their peak, often just as nutritious as fresh, and nothing goes to waste.
• Tinned fish, such as sardines, mackerel and pilchards, provide omega-3 fats and calcium cheaply.
• Eggs are one of the most affordable sources of high-quality protein.
• Seasonal and "wonky" vegetables, especially roots, cabbages and onions, are usually the best value.
• Home cooking in batches, such as soups, stews, dhals and lentil loaves, costs far less than ready meals and takeaways. (See our recipes.)

You don't need expensive superfoods. A pot of lentil soup with carrots, onions and garlic is as much a "superfood" as anything sold in a health food shop. (See Food as Medicine.)

Many of the most powerful things we can do for our health cost little or nothing.

Elite herbs, wild grown

Some of the most powerful and versatile medicines and tonics in herbal medicine grow all around us as "weeds", completely free. For centuries, this free pharmacy in the hedgerow was the medicine of ordinary families, and herbalists still prize these plants today: gentle enough to take for months, yet deeply restorative.

• Nettle, rich in iron, calcium and other minerals, makes a nourishing tea or soup. Pick the young tops in spring, wearing gloves.
• Dandelion leaves for salads and a gentle bitter for digestion, and roots for a liver tonic. (See Bitter Is Better.)
• Burdock, the tall plant with the sticky burrs, whose root is one of the great classic tonics: a cleansing herb for the liver, skin and lymph, and rich in inulin, a fibre that feeds healthy gut bacteria. In Japan the root is eaten as a vegetable, called gobo. Only dig roots with the landowner's permission, or grow your own.
• Cleavers, the sticky "goosegrass" of hedges and gardens, a traditional spring tonic for the lymphatic system, often taken as a cold infusion.
• Elderflower and elderberry: the flowers for summer cordials and teas, the cooked berries a traditional winter remedy. (Never eat elderberries raw.)
• Rosehips, very rich in vitamin C, for autumn syrups.
• Blackberries, one of the richest sources of protective polyphenols. A bag of berries in the freezer could see you through the winter.
• Wild garlic, which carpets woodlands in spring, for pesto and soups.
• Hawthorn flowers, leaves and berries, a traditional tonic for the heart.
• Plantain, the common "weed" of lawns and paths, a traditional soothing leaf for stings and bites.

Growing your own is cheap too: a pot of mint, thyme, rosemary, sage or chamomile on a windowsill costs very little and lasts for years.

Adaptogens closer to home. Even some of the celebrated adaptogens, the herbs that help the body cope with stress, grow here. Rhodiola, or roseroot, is a native British plant of Scottish sea cliffs and mountain ledges; wild plants should be left alone, but it grows well in a garden rockery. Liquorice has been grown around Pontefract in Yorkshire since at least the 1500s, first as a medicine for coughs and stomach complaints (it can raise blood pressure, so it isn't for everyone). Eleuthero and schisandra grow happily in British gardens, while ashwagandha and holy basil can be grown as summer plants or in a greenhouse. Reishi and lion's mane mushrooms are cultivated in the UK, but wild lion's mane is so rare that it's protected by law and must never be picked. (See Stressed Plants, Stronger Medicine and The Hidden Kingdom.)

Free ways to feel well

• Walking is free and one of the best things you can do for body and mind.
• Time in nature, in a park, by a river or in the woods, lowers stress and lifts mood. (See The Green Prescription.)
• Morning daylight sets the body clock for better sleep, mood and energy. (See Living by the Sun.)
• Breathing well calms the nervous system in minutes. (See The Healing Breath.)
• Sleep is the body's own repair programme. (See The Art of Sleep.)
• Friendship and community are as important to health as diet and exercise. (See Social Resonance.)
• parkrun holds free, timed 5k walks and runs in parks every Saturday morning across the UK, welcoming walkers, runners and volunteers of all ages and abilities.¹³
• Libraries, community gardens and social prescribing through your GP can connect you with free local activities, groups and support.

Natural beauty for next to nothing

Glowing skin starts from within, with sleep, water, plants and calm. On the outside, simple kitchen ingredients have been used for generations: an oat bath for itchy skin, a little honey as a face mask, olive or sunflower oil to moisturise, and cool chamomile tea bags for tired eyes. Fewer products also means a lighter chemical load. (See Skin Deep and Lightening the Load.)

Men: the missing patients

In the UK, men on average live around four years less than women. Part of the reason is that men are less likely to seek help. An analysis of UK general practice records found that men visited their GP about a third less often than women.¹⁴ They often wait longer before seeing a doctor about worrying symptoms, and are diagnosed later as a result.¹⁵

Many men grow up believing they should be strong, cope alone and not make a fuss. That belief can be deadly. Around three quarters of suicides in the UK are men, and many had not sought help in the year before they died.

If you're a man, or you love one, here are some reasons to book that appointment:

• Get the free NHS Health Check. In England, adults aged 40 to 74 are offered a free check-up every five years, looking at blood pressure, cholesterol and the risk of heart disease, stroke, diabetes and kidney disease. Ask your GP if you haven't been invited.
• Don't ignore the warning signs. A lump, a change in bowel or bladder habits, blood where it shouldn't be, unexplained weight loss, chest pain or breathlessness, erection problems (often an early sign of heart disease), or a mole that changes.
• Talk about how you feel. Low mood, anger, drinking more, withdrawing from people or feeling hopeless are signs that you need support, not signs of weakness.
• Find your people. Men's Sheds, walking groups, sports clubs and peer support groups such as Andy's Man Club offer connection, shoulder to shoulder. CALM (the Campaign Against Living Miserably) offers support for men in crisis.

Seeing your doctor early is not weakness. It's taking responsibility for yourself and for the people who rely on you.

The same reluctance reaches natural health care. Surveys of complementary medicine consistently find that the typical client is a woman,¹⁶ and many men assume herbalists and naturopaths are "not for them". Yet a naturopathic consultation often suits men well: it is private, practical and focused on finding causes rather than masking symptoms. Low energy, poor sleep, stress, digestive trouble, weight, blood pressure, prostate health and recovery from training are all common reasons men seek support. A good practitioner works alongside your GP, not instead of them, and will always ask you to have any warning signs checked first.

At Rootwise, men are every bit as welcome as women. If you'd like a straightforward plan that fits around your work, training and family life, a consultation is a good place to start.

At Rootwise, we believe natural health should be for everyone, not just the few. The plants, foods and practices we share are rooted in traditions that were once the medicine of ordinary people, and many of them are still free for us all.