We don’t have the answer - investigating health inequity
“Social injustice is killing on a grand scale.” Overstated? Not according to the World Health Organization. Sir Michael Marmot chaired its commission on social determinants in health and his stance hasn’t softened since publication of its report in 2008. When Sir Michael came to the Health and Sport Committee last May, he asked what sort of society we thought we were running. A good question! For over 40 years, health inequalities have been driven by a growing disparity in income, power and wealth. Successive administrations in Edinburgh and London – Labour, Lab-Lib, Con-Lib, SNP – none of us has dealt with this.
Sir Harry Burns, the former Chief Medical Officer, told the committee the story of health inequalities was “bedevilled by people who knew the answer”. We don’t have the answer. We do have questions. Why is it more equal societies enjoy better health outcomes? How important is community and quality of housing? Are the latest teenage pregnancy figures a sign of progress? What emphasis should we give ‘lifestyle drift’ or ‘the inverse care law’ or ‘proportionate universalism’? When do a family’s stress levels become intolerable? Is a zero-hours, poorly-paid, low-skilled job better than none at all? And where does the molecular biology of a hug come into all this? I defer to Sir Harry on that last one.
It’s a political choice, Sir Michael told us, that the worst-off should suffer more. Poverty wasn’t down to people shirking. “It’s because,” he said in a stage whisper,“people aren’t paid enough.” There were some hints of hope. He highlighted Birmingham City Council, which had succeeded in closing the gap in early childhood development. Tower Hamlets was also praised for its progressive policies. Closer to home, Sir Harry enthused about the Early Years Collaborative and the Family Nurse Partnership.
Sir Michael cited the example of Sweden, where leadership at the local level has been encouraged. Targeted services could make a difference but tackling health inequalities had to be “a corporate issue”. He talked about breaking down barriers in Norway to the extent that its Minister for Foreign Affairs could declare: “I’m the Minister for Health!” The principle is important. Responsibility should sit not only with our Cabinet Secretary for Health, Wellbeing and Sport but with all her ministerial colleagues.
It’s now more than 40 years since Jimmy Reid gave his rectorial address at the University of Glasgow, described by the New York Times as the greatest speech since the Gettysburg address. Harry Burns, who was a medical student there at the time – at Glasgow, not Gettysburg – said the comparison was rather over the top. That it flattered Abe Lincoln! But the theme of alienation rings as true today. As does Reid’s belief in the spirit and values of common humanity. He said: “Reject the insidious pressures in society that would blunt your critical facilities to all that is happening around you … This is not simply an economic matter. In essence it is an ethical and moral question.” Overstated? I think not.
The Health and Sport Committee published its first report of its inquiry into health inequalities on the 5th of January.
Read Stewart Maxwell, convener of the Education and Culture committee on how it is investigating inequality