Climbing ladders: From treatment to prevention (2025)

The game of snakes and ladders provides a stark metaphor for the health inequalities that we may face as we grow, live, work, and age.

Just as we cannot control the roll of the die in the snakes and ladders game, no one can choose the circumstances into which they are born. Disadvantage and inequity can shape our lives from the very beginning. Antenatal, and childhood living conditions, have a big impact on the chances of a long and healthy life. It's not unusual for a child who does not thrive to become an adult who does not thrive.

"Most of us cherish the notion of free choice, but our choices are constrained by the conditions in which we are born, grow, live, work and age."¹¹

Sir Michael Marmot

Missing or broken building blocks of health and wellbeing, result in issues such as poverty, unsafe and unaffordable housing, limited access to healthy food, and lower levels of education. These issues act as 'snakes' causing setbacks in health and wellbeing which can contribute to an increased chance of serious illness and lives cut short. Strong building blocks, such as high-quality education, good jobs, easy to access health and social care services, and supportive social networks act as 'ladders,' advancing health and wellbeing.

However, the health inequalities we face over the course of our lives are not random. The building blocks of health and wellbeing are interconnected and interact in a complex and dynamic way. This means that people from disadvantaged backgrounds, who face one broken building block, may experience a domino effect across others, encountering multiple 'snakes' that damage their physical and mental health.

For example, poverty can force people into poor housing, which increases exposure to damp and mould, leading to respiratory illness as well as hospital stays which makes it difficult for them to work and pushes them further into poverty.  People, from a wealthier background, may encounter more 'ladders,' such as help from their family to buy a house, or support from social networks to access work experience, increasing job prospects, and giving them more opportunities to improve their health.

By understanding more about the 'snakes' and 'ladders' which impact the health and wellbeing of people in Gateshead, the Council, and its partners, can increase their focus on prevention, to do more to address the causes of poor health and health inequalities. Acting to make the building blocks of health stronger isn't just about the avoidance of sickness. These actions can make a difference at every stage of life. If we can put more ladders in place, for the people who need them most, we can start to create a society where everyone has opportunities to be healthy.