English: Health inequality has been known for over 50 years, when Dr Julian Tudor Hart wrote an article in The Lancet on the inverse care law. The inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. He said: 'In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultation, than in the healthiest areas; and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings, and suffer recurrent crises in the availability of beds and replacement staff.' Has it changed? As Frank Dobson put it when he was Secretary of State for Health, 'Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you'll die sooner because you're badly off.' Then there's a social gradient in lifespan. People living in the most deprived areas in England and Wales have an average life expectancy of about nine fewer years than those in more affluent ones for men, and seven for women. Men and women living in the most deprived areas can expect nearly 20 fewer years in good health. So, people not only die younger but are ill for a larger period of their life. If I were living now in the area I went to school, the likelihood is, as a man of over 60 years of age, it would be over 50 per cent that I would be suffering from serious ill health. Almost half the gap in life expectancy between the two areas is due to excess deaths from heart disease, stroke and cancer. As well as lower life expectancy, there's a higher prevalence of many behavioural risk factors among the most deprived areas compared with the less deprived areas. These health inequalities are underpinned by inequalities of both social and economic circumstances that influence health. Health cannot be looked at on its own. The unequal distribution of the social determinants of health, such as education, housing and employment, drives inequality in physical and mental health, reducing individuals' ability to prevent sickness or to take action and access treatment when ill health occurs. People cannot afford to stay home from work when they are ill because the effect it has on their income. That has a serious effect on their life expectancy in the long run, but it certainly affects them very badly in the short term. These inequalities are complex; they are embedded in society. But they're also preventable. The dimensions of inequality are complex and overlapping, as is representing the overlapping dimensions of health inequality. Health inequalities such as deprivation, low income and poor housing have always meant poorer health, reduced quality of life and early death for many people. The COVID-19 pandemic has starkly exposed how these existing inequalities and the interconnection between them, such as race, gender and geography, are associated with an increased risk of becoming ill with a disease such as COVID-19. But it would be true of any pandemic. The link between poor housing and poor health is well established. Clement Attlee created a ministry of health and housing under Nye Bevan. Unfortunately for me, no Labour leader since has managed to join the two together. The Labour Party has a strong and proud record of providing good-quality social housing, and this leads to improved health for the residents of these properties. But we also have people living in cold, damp and unsuitable privately rented accommodation. Is it any surprise that they have poor health and many children have poor educational outcomes? Homelessness has a huge impact on a person's physical health. Sleeping rough makes it difficult to get good-quality sleep, maintain an adequate and healthy diet, stay clean and take medical treatment. It's not surprising that research by University College London discovered at least one third of homeless people have died from readily treatable conditions, and almost all of them died young. Many studies have found a direct link between good health and interaction with the natural environment, with stress lowered, obesity rates lessened and concentration improved. Health inequality is just another manifestation of poverty: poor diet, poor-quality housing, inadequately heated housing, lack of interaction with the natural environment, lack of exercise, and continually worrying about money inevitably producing less good health outcomes and early death. Can I just finish by talking about worrying about money? I think it comes as a shock to most of the people in the Senedd, but there are large numbers of my constituents who daily worry about the amount of money they've got and how they're going to pay their bills. They live throughout my constituency, and I think that, really, it's about taking that stress away. I remember once saying that if I was in that situation of not knowing how I was going to feed my children, if I didn't know how I was going to pay my rent, I would be depressed as well, and it seems mental health is driven by the fact that people are poor. So, let's deal with the real cause of it, which is poverty and poor housing, and if we can deal with those, then we can improve health and health outcomes.
Welsh: Mae anghydraddoldeb iechyd wedi bod yn ffenomen hysbys ers dros 50 mlynedd, pan ysgrifennodd Dr Julian Tudor Hart erthygl yn The Lancet ar y ddeddf gofal gwrthgyfartal. Y ddeddf gofal gwrthgyfartal yw'r egwyddor fod argaeledd gofal meddygol neu gymdeithasol da yn tueddu i amrywio'n wrthgyfartal ag angen y boblogaeth a wasanaethir. Dywedodd: 'Yn yr ardaloedd sydd â'r lefel fwyaf o salwch a marwolaethau, mae gan feddygon teulu fwy o waith, rhestrau mwy, llai o gymorth ysbytai, ac maent yn etifeddu traddodiadau ymgynghori mwy aneffeithiol yn glinigol nag yn yr ardaloedd iachaf; ac mae meddygon ysbyty'n ysgwyddo baich achosion trymach gyda llai o staff ac offer, adeiladau mwy hynafol, ac yn dioddef argyfyngau rheolaidd o ran argaeledd gwelyau a staff cyflenwi.' A yw wedi newid? Fel y dywedodd Frank Dobson pan oedd yn Ysgrifennydd Gwladol dros Iechyd, 'Anghydraddoldeb ym maes iechyd yw'r anghydraddoldeb gwaethaf oll. Nid oes anghydraddoldeb mwy difrifol na gwybod y byddwch yn marw'n gynt oherwydd eich bod yn dlawd.' Hefyd, ceir graddiant cymdeithasol mewn hyd oes. Mae disgwyliad oes cyfartalog pobl sy'n byw yn yr ardaloedd mwyaf difreintiedig yng Nghymru a Lloegr oddeutu naw mlynedd yn llai na'r rhai mewn ardaloedd mwy cyfoethog i ddynion, a saith mlynedd i fenywod. Gall dynion a menywod sy'n byw yn yr ardaloedd mwyaf difreintiedig ddisgwyl bron i 20 mlynedd yn llai o iechyd. Felly, mae pobl nid yn unig yn marw'n iau ond yn sâl am gyfnod hwy o'u bywydau. Pe bawn i'n byw yn awr yn yr ardal lle roeddwn i'n mynd i'r ysgol, fel dyn dros 60 oed, byddai'r tebygolrwydd y byddwn yn dioddef o afiechyd difrifol dros 50 y cant. Mae bron i hanner y bwlch mewn disgwyliad oes rhwng y ddwy ardal yn ganlyniad i farwolaethau ychwanegol o glefyd y galon, strôc a chanser. Yn ogystal â disgwyliad oes is, mae llawer o ffactorau risg ymddygiadol yn llawer mwy cyffredin yn yr ardaloedd mwyaf difreintiedig o'u cymharu ag ardaloedd llai difreintiedig. Mae'r anghydraddoldebau iechyd hyn yn seiliedig ar anghydraddoldebau mewn amgylchiadau cymdeithasol ac economaidd sy'n dylanwadu ar iechyd. Ni ellir edrych ar iechyd ar ei ben ei hun. Mae dosbarthiad anghyfartal penderfynyddion cymdeithasol iechyd, megis addysg, tai a chyflogaeth, yn gyrru anghydraddoldeb mewn iechyd corfforol a meddyliol, gan leihau gallu unigolion i atal salwch neu gymryd camau a chael triniaeth pan fydd afiechyd yn digwydd. Ni all pobl fforddio aros adref o'r gwaith pan fyddant yn sâl oherwydd yr effaith y mae'n ei chael ar eu hincwm. Mae hynny'n effeithio'n ddifrifol ar eu disgwyliad oes yn hirdymor, ond mae'n sicr yn effeithio'n wael iawn arnynt yn y tymor byr. Mae'r anghydraddoldebau hyn yn gymhleth; maent wedi'u gwreiddio mewn cymdeithas. Ond mae modd eu hatal hefyd. Mae dimensiynau anghydraddoldeb yn gymhleth ac yn gorgyffwrdd, fel y mae cynrychioli dimensiynau anghydraddoldeb iechyd sy'n gorgyffwrdd. Mae anghydraddoldebau iechyd fel amddifadedd, incwm isel a thai gwael bob amser wedi golygu iechyd gwaeth, ansawdd bywyd gwaeth a marwolaeth gynnar i lawer o bobl. Mae pandemig COVID-19 wedi amlygu'n glir sut y mae'r anghydraddoldebau hyn sy'n bodoli eisoes a'r rhyng-gysylltiad rhyngddynt, megis hil, rhyw a daearyddiaeth, yn gysylltiedig â risg uwch o fynd yn sâl gyda chlefyd fel COVID-19. Ond byddai'n wir am unrhyw bandemig. Mae'r cysylltiad rhwng tai gwael ac iechyd gwael wedi'i hen sefydlu. Creodd Clement Attlee weinyddiaeth iechyd a thai o dan Nye Bevan. Yn anffodus i mi, nid oes unrhyw arweinydd Llafur ers hynny wedi llwyddo i uno'r ddau gyda'i gilydd. Mae gan y Blaid Lafur hanes cryf a balch o ddarparu tai cymdeithasol o ansawdd da, ac mae hyn yn arwain at well iechyd i drigolion yr eiddo hyn. Ond mae gennym hefyd bobl sy'n byw mewn llety rhent preifat oer, llaith ac anaddas. A yw'n syndod fod eu hiechyd yn wael a bod llawer o blant yn cael canlyniadau addysgol gwael? Mae digartrefedd yn effeithio'n enfawr ar iechyd corfforol unigolyn. Mae cysgu ar y stryd yn ei gwneud yn anodd cael cwsg o ansawdd da, cynnal deiet digonol ac iach, cadw'n lân a chael triniaeth feddygol. Nid yw'n syndod fod ymchwil gan Goleg Prifysgol Llundain wedi darganfod bod o leiaf draean o bobl ddigartref wedi marw o gyflyrau y gellid eu trin yn hawdd, a bu farw bron pob un ohonynt yn ifanc. Mae llawer o astudiaethau wedi canfod cysylltiad uniongyrchol rhwng iechyd da a rhyngweithio â'r amgylchedd naturiol, gyda lefelau is o straen, cyfraddau gordewdra is a gallu gwell i ganolbwyntio. Arwydd arall o dlodi yw anghydraddoldeb iechyd: mae deiet gwael, tai o ansawdd gwael, tai wedi'u gwresogi'n annigonol, diffyg rhyngweithio â'r amgylchedd naturiol, diffyg ymarfer corff, a phryder parhaus am arian yn anochel yn cynhyrchu canlyniadau iechyd heb fod cystal a marwolaethau cynnar. A gaf fi orffen drwy sôn am boeni am arian? Credaf ei bod yn sioc i'r rhan fwyaf o'r bobl yn y Senedd, ond mae nifer fawr o fy etholwyr yn poeni'n ddyddiol ynglŷn â faint o arian sydd ganddynt a sut y maent yn mynd i dalu eu biliau. Maent yn byw ym mhob rhan o fy etholaeth, ac mewn gwirionedd, rwy'n credu ei fod yn ymwneud â chael gwared ar y straen hwnnw. Rwy'n cofio dweud unwaith, pe bawn i mewn sefyllfa lle na fyddwn yn gwybod sut oeddwn i'n mynd i fwydo fy mhlant, pe na bawn yn gwybod sut oeddwn i'n mynd i dalu fy rhent, byddwn innau hefyd yn ddigalon, ac mae'n ymddangos bod iechyd meddwl yn cael ei yrru gan y ffaith bod pobl yn dlawd. Felly, gadewch inni fynd i'r afael â'r gwir achos, sef tlodi a thai gwael, ac os gallwn ymdrin â'r rheini, gallwn wella iechyd a chanlyniadau iechyd.