Addressing health inequalities can help reduce anxiety

For Mental Health Awareness Week, our Chair of Trustees Jenny Edwards CBE discusses the relationship between anxiety, stress, our mental health and health inequalities.

Anxiety has become more prevalent over recent decades, particularly for young adults tripling for the under 25s. Our mental health is directly affected by our ability to connect with one another, our living standards, our sense of control over our lives and our environment. When these decline, rates of stress and anxiety increase. Over the past ten years or so, the effects of austerity, insecurity of work and housing, the Covid-19 pandemic and the rising cost of living have coincided with rising rates of anxiety.

Stress and anxiety are related. Stress is a natural condition that, working well, can spur us into action. When we and the conditions we live in are healthy then we naturally recover, helped by relaxation, sleep, eating well, getting out into nature and the support of those we care for. Problems start when the stress we experience overwhelms us in intensity or because it is deep seated, frequent, continuous or from many directions at once. This accumulates as what is sometimes referred to as the allostatic load. This impacts on a range of key biomarkers that affect our health in many ways and are associated with serious health conditions such as diabetes, cardiovascular disease, lowered immunity, addictions, asthma, arthritis and clinical levels of anxiety. A useful explanation of different levels of stress can be found here.

When I worked for some years in the homelessness sector I came to understand the fundamental links between homelessness and mental ill health. Eight in ten homeless people experience high levels of anxiety and depression and often trauma. The experience of homelessness itself created daily anxiety. Often this was layered on top of anxiety arising from a lifetime of experiencing disadvantage. More than a quarter of homeless people cite mental health problems as the reason they became homeless.

People not feeling that they have a secure home is also a major cause of anxiety. The link between financial and mental distress is particularly acute for people who rent, have insecure work and for families with minimal or no savings. Poor sleep and feelings of worthlessness are more common. Young people living in cold homes are particularly vulnerable to multiple mental health problems when compared to those in warm homes. Anxieties are linked to debt/affordability of heating and damage to possessions through mould.

When I worked at the Mental Health Foundation we commissioned the National Centre for Social Research (NatCen) to conduct a detailed survey of mental health in Great Britain. This showed that nearly two thirds of people have experienced a mental health problem, including 85% of people who were out of work. A 2022 survey for the Mental Health Foundation found that people are experiencing widespread levels of stress, anxiety and hopelessness in response to financial concerns. 29 per cent of adults experienced stress, 34 per cent experienced anxiety and ten per cent said they felt hopeless. They were concerned about not being able to maintain their standard of living (71 per cent), heat their home (66 per cent) or pay general monthly household bills (61 per cent). Half of the people surveyed were worried about being able to afford food over the next few months, rising to two thirds of young adults.

Poverty disproportionately affects Black and minority ethnic communities, as shown by Runnymede Trust and government data. Black women experience a higher level of poor mental health, with almost one in three each week reporting a common mental health problem. Racism also has a direct impact on the allostatic load and therefore can affect a wide range of mental and physical health risks. In addition, there is inequity in treatment rates. People from all ethnic minority groups are less likely to receive interventions, for example, for problems like anxiety or depression.

The wider environment can have a major impact on our health in general. Health inequality is reduced in areas which have more green space. Mortality rates from all causes are 43 per cent higher for disadvantaged groups who live in green areas, compared to 93 per cent higher for disadvantaged groups who live in less green areas. Green spaces are also known to have an impact on our mental health and can reduce anxiety levels, both through connection with nature and through providing space for social activities and physical activity. I volunteer regularly in my local park and have lost count of the number of people who describe how important to their mental health it is to visit nature, pay attention to all aspects of the natural world and often to help out. For children and young people, entering into green space can be an adventure, a challenge and a place to play and discover what they are capable of doing. This is linked to better mental health, including improvements in memory, attentiveness and learning ability, and a reduction in stress and anxiety.

However we also know that there are real inequalities in access to green environments. The most affluent 20 per cent of neighbourhoods in England have five times the amount of green space than the most disadvantaged ten per cent. Health damaging environments include those with high levels of external pollutants, such as traffic fumes, and internal pollutants such as mould. These conditions are known to affect anxiety, depression, attention and sleep, as well as physical ill health.

Things can and must change. Mental ill health has been described as the greatest cause of misery in the world. The mental health inequalities that we experience in this country can be tackled and ended, but we must start from the building blocks of health. That is why we have joined with 27 other organisations to create the Health Equals campaign to change the public conversation about health. It's time for change on anxiety, mental health and so much more.