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by Tom Freeman
27 May 2014
Talking point: Equal choice

Talking point: Equal choice

Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London, is a world leader in health inequalities, so when he presented evidence to the Scottish Parliament’s Health and Sport Committee recently, I was keen to hear him.
His review, published in 2010, brought notions of ‘proportionate universalism’ back into the political vocabulary and recommended six policy objectives: giving every child the best start in life; enabling people to maximise their capabilities and have control over their lives; creating fair employment and good work for all; ensuring a healthy standard of living for all; creating and developing healthy and sustainable places and communities; and strengthening the role and impact of ill-health prevention.
In committee, Marmot remembered showing an economist at the Treasury a graph of the gradient of inequalities: “He said, ‘Oh, don’t come to me with that Scandinavian nonsense—we’re Anglo-Saxons here,’ adding, ‘We focus on the worst off. That’s the default position of British social policy, and this Scandinavian nonsense is not for us.’”
Marmot said he was careful not to make political points, but to point out the political choice being made. “If the Chancellor says he is happy with that choice, that is absolutely fine. However, I feel a responsibility to say, ‘That will damage our children.’”
“I addressed 7,000 public health people at the American Public Health Association and said, ‘You live in a democracy. I couldn’t care less whether the policy is Democrat or Republican, this must be the level of child poverty you want, otherwise you would elect a government that did something different.”
If ordering priorities is a political choice, can’t we describe the decisions made at every level in Scotland as political? When it comes to allocating resources, what are the priorities of the organisation? In effect, are we as ‘Anglo-Saxon’ as the Treasury economist would have us believe, or can we all make choices to rebalance health inequalities?

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