#InPoverty: The stark reality of health poverty as Wales struggles to breathe

Deprivation and rising levels of inequality are making the worse off unhealthier and in the fight for health Wales cannot catch its breath

More deprived areas are more likely to have to use not only a ventolin inhaler but a steroid preventer inhaler too

Wales has the highest asthma mortality rate in Europe, five times higher than Sweden, Germany and Portugal. In 2015 respiratory illness accounted for 16% of all deaths in Wales.

Poverty is making Wales sick. Around three people die from asthma a day. Wales is the worst place in the UK to be an asthma sufferer, with more deaths per year than the rest of the UK.

What is worse is that around half of all asthma deaths in Wales are avoidable.

In a study by Asthma UK it was found that the more deprived asthma patients had 31% more A&E visits and 123% more hospitalizations

So what are the connections between deprivation and poor health?

Asthma UK, found that more deprived asthma patients had 31% more A&E visits and 123% more hospitalizations. People who live in fuel poverty cannot afford to heat their homes and are more likely to get sick. Derelict housing can cause serious health problems.

Risk factors include, mould, damp, formaldehyde or indoor smoke.

Formaldehyde is a chemical found in household goods such as MDF furniture and carpet.

What needs to be done?

Progress in education

Respiratory illnesses, such as asthma, require self management, and people who have a lower level of health literacy might underestimate the seriousness of such conditions.

Understanding is very limited. People are unaware of how serious it can be

NHS Professional Sam says education and health literacy are very important, as those from a working class background are less likely to be aware of how to appropriately manage asthma.


Joseph Carter, the Welsh head of the British Lung Foundation explained that more education is needed for those in deprivation, “Understanding is very limited. People are unaware of how serious it can be.”

Stop smoking schemes

Tobacco smoking is the leading cause of COPD. (Chronic obstructive pulmonary disease (COPD) includes emphysema, chronic bronchitis and non-reversible asthma.)


Public health Wales in 2016 found that smoking among adults is 2.4 times higher in the most deprived fifth compared to the least deprived.

Wales has more smokers than England and younger smokers, some starting as early as 15.  

Joseph said stop smoking schemes need to target whole families and not just individuals.

The National Survey for Wales from 2016/17, found that 19% of the population in Wales smoke and 59% are overweight or obese. These are both contributing factors to respiratory disease.


Poor air, poor health

Another major contributor to respiratory illness is air pollution. Environmental law firm Client Earth found that areas of Wales are breaching the legal NO2 limit.

Poor air quality is estimated to kill 143 in Cardiff each year.

People have been breathing illegal levels of pollution for years. Public Health Wales argue that the number of deaths from poor air quality per year has increased to over 225 across Cardiff and the Vale of Glamorgan.

People have been breathing illegal levels of pollution for years

Joseph says, “People who are concerned with air pollution and respiratory illness are often those not affected by it. It should not be a simply middle class interest. We need to reach those who live in deprived areas and raise awareness,” he said.

The stark facts about health poverty in Wales

Case Study

Elis Williams, 22, from Ystalyfera in Swansea developed a chest infection while at Cardiff university.

With heating bills so expensive for students his student house was so cold it impacted his health.

“It’s quite shoddily built so the insulation is terrible especially in my bedroom, because it’s part of an extension and it has 3 outside walls,” he said.

After attending hospital Elis was sent to his parents house on doctors orders and told not to go back to his cold student house.

What is being done about it?

The Welsh Government Warm Homes Programme from 2012 pays the energy bills, adds housing insulation and replaces boilers.

So far the programme has invested £150 million and affordably heated 27,000 homes.

4% of recipients saw a decrease of respiratory illness compared to the previous year and 6.5% of asthma sufferers experienced a decrease in symptoms.

This is important because Public Health Wales found in 2016 that 40% of adults aged 16-44 were unable to keep up with household bills.

Professional Perspective

NHS professional, Samantha Metcalfe, says the link between deprivation and illness is situational as poor quality housing and manual labour can lead to poor health.

Occupation plays a role, as manual jobs may include exposure to dust, asbestos, building rubble and chemicals, which may exacerbate any respiratory illness.

What is the impact?

Respiratory diseases are the third most common illness in the UK and Wales has the highest childhood prevalence rates in the world.

Around half of all asthma deaths in Wales are avoidable

The Royal College of Paediatrics said poverty is the biggest threat to children’s health in Wales.

In 2015 COPD accounted for 16% of all deaths in Wales

The NHS, spend upwards of £1 billion a year treating people with asthma. In Wales the cost is estimated at just over £211 million, with over £40 million on prescriptions.

With the highest asthma mortality rate in all of Europe, the problem of respiratory illness in Wales needs to be addressed.

Wales has a higher death rate for Asthma sufferers than anywhere else in the UK

The Welsh government aim to tackle nitrogen dioxide levels in Wales in a new report in November 2018, with this and the respiratory health action plan, Wales is moving in the right direction.

Deprivation induced illness is easily avoidable and with more investment in stop smoking schemes, the warm homes programme and improved understanding, the unnecessary deaths can stop.

Take a look at this!